Radiotherapy, lobectomy or sublobar resection? A meta-analysis of the choices for treating stage I non-small-cell lung cancer

Whether stereotactic ablative radiotherapy (SABR) is comparable to surgery in treating stage I non-small-cell lung cancer (NSCLC) is unknown. Therefore, we conducted this meta-analysis to compare the efficacy of SABR with that of surgery in treating stage I NSCLC. A systematic literature search in PubMed, Embase, Cochrane Library databases and Google Scholar as well as the American Society of Clinical Oncology was conducted to identify relevant studies dated through 31 December 2015. Data including 3-year survival rate, overall survival (OS) and 3-year loco-regional control (LRC) rates were extracted and analysed. No complete randomized controlled trials but 12 cohort studies were included with a total of 13 598 patients. Meta-analysis showed a significantly lower 3-year survival rate (risk ratio = 0.78; 95% confidence interval [CI] = [0.68, 0.90]; P = 0.001) and shorter OS (hazard ratio = 1.60; 95% CI = [1.24, 2.06]; P < 0.001) for patients treated with SABR compared with surgery. No difference in the 3-year LRC rate was observed between SABR and surgery (risk ratio = 0.95; 95% CI = [0.82, 1.09]; P = 0.453). Subgroup analysis was conducted on the basis of surgical procedures. In the subgroup analysis, SABR was found to yield significantly shorter OS than lobectomy (hazard ratio = 1.68; 95% CI = [1.09, 2.60]; P = 0.018), whereas SABR was comparable to sublobar resection in terms of 3-year survival rate, OS and 3-year LRC rate. Our meta-analysis found that lobectomy yielded better survival outcomes than SABR, whereas SABR yielded comparable rates when compared with sublobar resection. Lobectomy is still the preferred method for treating earlystage NSCLC. Well-designed and multicentred randomized controlled trials with large sample sizes, however, are needed to confirm and update our conclusions.